Basic Information
| Provider Information | |||||||||
| NPI: | 1073143848 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANDRA M. HAYES, MEDICAL SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 446 PALM AVE | ||||||||
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| City: | CORONADO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921181723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192586200 | ||||||||
| FaxNumber: | 6192580028 | ||||||||
| Practice Location | |||||||||
| Address1: | 1940 EL CAJON BLVD | ||||||||
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| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921041005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195434500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2020 | ||||||||
| LastUpdateDate: | 01/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | STEMMLER | ||||||||
| AuthorizedOfficialFirstName: | KARL | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6192586200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MPA | ||||||||
| NPICertificationDate: | 01/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0011X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine |
No ID Information.